Distinct predictors of patient quality of life and care partner burden in idiopathic normal pressure hydrocephalus: the role of neuropsychiatric symptoms

Idiopathic normal pressure hydrocephalus (iNPH) is characterized by ventriculomegaly with gait, urinary, and cognitive dysfunction. It can also manifest with neuropsychiatric symptoms. We investigated predictors of patient quality of life (QoL) and care partner burden in patients with suspected iNPH. Patients (N = 186, Mage=74.73 ± 8.36 years, Meducation=14.50 ± 3.44, 38.7% female, 96.2% non-Hispanic white) self-reported their mobility, urinary and neuropsychiatric symptoms (anxiety, depression, apathy), and QoL. Care partners reported on emotional burden. Global cognition was measured with Mini-Mental Status Examination (MMSE). Neuropsychiatric symptoms were prevalent [depression (58%), anxiety (51%), and apathy (72%)]. Hierarchical multivariate model adjusted for education showed greater urinary, mobility, depression, anxiety, and apathy symptoms were associated with poorer patient-reported QoL (β’s = −0.42 – −0.11, p’s < 0.043). In contrast, greater patient depression, apathy, and cognitive symptoms, but not urinary symptoms or mobility, predicted greater care partner burden (β’s = −0.19–0.26, p’s < 0.047). Patient QoL in iNPH is associated with symptoms typically improved with shunting (i.e., gait, urinary), while care partner burden is more closely tied to neuropsychiatric symptoms. Findings highlight the importance of assessing neuropsychiatric symptoms during comprehensive diagnostic work-up. Future studies should examine neuropsychiatric symptom response post-shunt to appropriately counsel patients and families.